South Bend Rental Application

This is a secure form.

South Bend Rental Application must be filled out in its entirety. Only leave blank those fields that do not apply to you. We will call you if you are missing information and your application will not be processed. We look forward to receiving your South Bend Rental Application.

Property address you are applying for:

Applicant Information:		Spouse/Co-Applicant Information

Name:		Name:
SSN:		SSN:
Home Phone:		Home Phone:
Cell:		Cell:
Email:		Email:
Date of Birth:		Date of Birth:
Employer Name & Phone:		Employer Name & Phone:
Occupation:		Occupation:
Salary:		Salary:
Supervisor:		Supervisor:
Dates of Employment:		Dates of Employment:
Other Sources of Income:		Other Sources of Income:
Current Address:		Current Address:
City, State, Zip:		City, State, Zip:
Landlord Phone:		Landlord Phone:
Dates at this Address:		Dates at this Address:
Reason for Moving:		Reason for Moving:
Amount of Rent or Mortgage:		Amount of Rent or Mortgage:
Names and Birthdays of every person who will reside with you:		Names and Birthdays of every person who will reside with you:




Do you have a criminal record? If so, what?		Do you have a criminal record? If so, what?
Have you ever been evicted? If so, why?		Have you ever been evicted? If so, why?

The following to be filled out by the first applicant only:

Reference (Relative):		Reference (Non-Relative):
Name:		Name:
Phone:		Phone:
Address:		Address:

Do you WANT to own a home? If yes, WHY?		Have you received your deposit back? If not, why?
If you WANT to own a home, how much of a down payment can you raise in 90 days?		Have you filed for Bankruptcy? When?
Have the police ever been called to your residence? Why?		Do you receive Section 8?
How much can you afford for a monthly payment?		If you received Section 8, how much $ and how many bedrooms?
How much do you have saved for a deposit?		If you are qualified, how much can you afford a month to buy your own home?
Desired Occupancy Date:		Have you EVER broken a lease? Why?
Type & Weight of all Pets who will live with you:		Any Additional Comments:

Rental Credit Application Terms and Condition:

I declare that the statements above are true and correct. I hereby authorize verification of all information given and the obtaining of a investigative consumer credit report, criminal record, rental history, police report and any other report deemed necessary by Landlord. The landlord and/or agents are able to re-check any of the reports at any time if felt necessary. I understand that the application fee, where allowed by state law, of $25.00 per applicant is non-refundable.
I agree to the above Terms & Conditions: